The WAITING ROOM => GENERAL KNEE QUESTIONS and comments (good for new threads) => Topic started by: FormerlyActive on June 10, 2008, 06:01:31 AM

Title: What surgery do you have years after a lateral release?
Post by: FormerlyActive on June 10, 2008, 06:01:31 AM
Hello - Last time I had surgery (19 years ago) I had severe patellafemoral pain for one year then finally find a doctor who tried lateral release both knees. On the surgery tape it showed when extended my knee was 1/2 way off the groove, it didn't go into the groove until bent at 45 degrees. No wonder I had so much pain standing! The lateral release on both knees saved me, my knees were better than they had ever been and I went back to teaching aerobics for 5 more years. However I have miserable malalignment since birth, which doesn't help for knee tracking. After some hikes in New Zealand in March my left knee has been disabled and it feels just like 19 years ago. I suspect the kneecap is pulling way to outside again. But you only have the lateral release once, so what can they do? 19 years ago PT was not enough to combat the powerful forces of my malalignment and I suspect it won't be enough pull the kneecap back in line now.  I got new orthotics but didn't help.

Can anyone say if they had this problem again and what was their next surgery? Did they have medial imbrication (tightening on medial side to try to pull it in)? The PT taped me two different ways and had me go on a step but my knee was already swollen and I really couldn't tell if it helped. They called it "inconclusive". I asked the doctor about medial imbrication and she said "well if the taping didn't work then its not indicated" but I don't think a few minutes of tape is a sufficient time or test. Now she is still diagnosing me, I had the gait analysis and wait 4-8 weeks for results. However I think I know my own body and I really suspect the kneecap is pulling way to outside. They can't seem to tell this without doing an arthroscope, but aren't ready to do one. Appreciate any info as to what you had after lateral release but kneecap pulling to outside?   
Title: Re: What surgery do you have years after a lateral release?
Post by: JustMeInNC on June 10, 2008, 05:13:49 PM
I had a lateral release done on my right knee 10 years ago. Recently it started hurting so bad that I told my doctor that I could no longer stand the pain and we had to do something. He went in with the scope and had to do the lateral release again. He said that there was so much damage that everything had tightened back up again. Unfortunatly he also told me that I will need more surgery to help with the problem that I am having and will find more about that today  :)
Title: Re: What surgery do you have years after a lateral release?
Post by: Cid on June 10, 2008, 07:01:49 PM
After having a lateral release on both knees I had to have a vmo advancement to keep my patellas in position.  I wish I could say it fixed everything but I still have problems and have had multiple procedures since.  I had a TTT before the VMO and I have to say that knee has less problems but I have still had 5 surgeries on each knee for debraidment, micordrilling and multiple miniscus repairs and removal.  Im just thankful for a good OS and am able to do most everything I want.  Don't give up and keep moving.  Good Luck.  Cid
Title: Re: What surgery do you have years after a lateral release?
Post by: TwoBadKneesUSA on June 10, 2008, 08:34:16 PM
I also had a LR on both knees about 19 years ago.  Worked great for a while.  I needed more sugery over the past three years.  I got by with a debridgement on the right knee for a couple of years.  Then last July I had them scope both knees and another LR was done on the left side (it was pulled laterally again).  Unfortunately it did not help this time and I will eventually need a VMO advancement and an open release to get the kneecap back in place.  You may want to have it checked out by another OS if you can.  I wonder why it takes 4-8 weeks to get the results of a gait analysis?  I haven't had one in 20 years so I'm not sure if that's a standard wait time or not.  The waiting gets to you and in the mean time you hurt.  Good luck.
Title: Re: What surgery do you have years after a lateral release?
Post by: ex-gymnast on June 11, 2008, 02:06:31 AM
I had an LR in '98 (sorry guys I was 12 when ya'll had surgery)  Mine never worked so I have a brace that basically holds my kneecap in place.  (It also works as an stubality brace.)  When my kneecap starts sliding, it normally sublexes but sometimes moves laterally, i just wear my brace
Title: Re: What surgery do you have years after a lateral release?
Post by: FormerlyActive on June 18, 2008, 05:51:05 AM
Thanks to you all for your answers. My conclusions from our small sample size, and other posts on this board, is that the LR is (or was) often the initial surgery for patella problems. For some people it did not solve their issues long term, it might not have been the right surgery for their particular condition.

Subsequent surgeries then which people had were more serious and more specific to their individual knee problems, so there were a wide variety. There does not seem to be a common "next surgery" although the TTT and VMO advancement are mentioned quite often and sound major in terms of risk, recovery and future outcomes. Some people had their lateral releases repaired, I think in an effort to improve stability, while a few mentioned having them "done over", so perhaps that was releasing even more.

The reason I ask, which I think I mentioned, is that my LR's on both legs worked well for 19 years and now I suspect the kneecap is pulled to the outside again on the left one, and I was wondering what the next step was for others (for whom it was already cut). A heartfelt thank you to those who responded.
Title: Re: What surgery do you have years after a lateral release?
Post by: TwoBadKneesUSA on June 18, 2008, 02:03:23 PM
I also had previous LR and it was only successful for about 10 years.  I have deficient VMO muscles so things on the lateral side tightened up again.  Could be what you are also experiencing?  This time I think I had more going on than the LR was going to fix, so it did not help this time.  A VMO advancement and open release were discussed, but it's all on hold right now.  Good luck.
Title: Re: What surgery do you have years after a lateral release?
Post by: FormerlyActive on June 18, 2008, 06:44:42 PM
Yes! I really suspect that is it, that the kneecap is pulling to the outside when I stand, my symptoms are so similar to 19 years ago. I asked the doctor can they cut anything else and she said No (this was yesterday but she is not my surgeon). That is very interesting about the open lateral release, would they be thinking of cutting something else then? Do you know what it would be? They used to do all the LRs as open surgery previously. Also just wondering why all is on hold are you trying PT to strengthen those muscles? Thanks so much for your perspective.
Title: Re: What surgery do you have years after a lateral release?
Post by: TwoBadKneesUSA on June 18, 2008, 08:29:29 PM
From what my OS said the open release is about the same as the scope.  The knee would need to be opened to do the VMO advancement.  The lateral renticulum is cut to allow the kneecap to move more toward the center of the femoral grove and then the attachment of the VMO is released and reattached elsewhere on the kneecap to help pull the kneecap mediallly.  That's how it was explained to me.  I am not currently in PT, but I still try to keep up with the home program.  I've though about seeing my primary doc and ask for a referral as the VMO seems very stubborn.  I am fed up with most of the PT places in town because of scheduling and the last one released me too soon.  I still had a limp and could not walk downstairs normally (still a challenge).  So when I can find one that will work with me on appointment times, I'll give it another try.  Some of why it's on hold is I don't think my current OS knows what else to do.  I've had some Supartz shots (basically to lubricate the joint) that did help the pain somewhat, but still an issue.  He basically said to just wait and see the last time I saw him.  I am going to get my records and surgical notes and try another OS, but he's about 2 hours away.  I figured that while I was waiting for the records and appointment scheduling I could at least try to get the muscles stronger.

The biggest problem is finding out what is causing the knee problems.  Once a good handle on that is obtained it seems like a better treatment plan gets worked out.

Good luck.
Title: Re: What surgery do you have years after a lateral release?
Post by: kimmyxs on June 19, 2008, 01:49:41 AM
I have had misalignment in my knees for forever.  Over a period of years I had one major patella dislocation and many, many sublux to the lateral side.  2 years ago yesterday, I had a major dislocation, I tensed and my very strong quads snapped the patella in half vertically - yes I broke a bone that only breaks 2% of the time in a direction that happens rarely, and breaks this way only 2% of the time.  It took 6 months to regain about 100 degrees ROM.  I had the hardware removed in order to increase ROM.  When the surgeon had the knee open and tried to get the patella to stay in place - it fought back.  He was amazed I survived as long as I had.  He said he had never had that problem before.  He did a VMO advancement and LR to get the patella to stay in place.  When I woke up from surgery, I was NOT a happy camper because I was back in a ROM brace for 6 weeks.  Because a VMO advancement is a muscle graft, I took PT very slowly.  Today a year and a half past that surgery, I am doing things I hadn't done since high school.  PT was hard, but I was released by both the PT and the OS at 10 weeks - both said that was a record for them and I was 48.  I was so very pleased.  It was the best thing I ever did.  Thank goodness.

Good luck and see a second surgeon.  Have a great pt and that helps as well.
Title: Re: What surgery do you have years after a lateral release?
Post by: SarahMN on February 09, 2009, 04:51:39 AM
Hi, I live in Mendota Heights and noticed you had seen someone at Tria.  I had a LR on one knee, am 12 weeks out and hurting.  I need a lot of pain med just to do PT.  I cannot walk much beyond the end of my driveway.  I would send you a message, but I don't know how.  I would love to compare notes on OS. 

They seem to have totally different ideas on how to treat my knees.  The other (left) knee is in the same shape as the right one was, and I was supposed to have had surgery, but have not as this isn't turning out so well.  Or the recovery is taking so long.

I am hoping to see Steadman in Vail out of desperation at the end of March.